Introduction: There are only sparse data concerning individual coronary side branch (CS-SB) anatomy with respect to LV lead implantation for cardiac resynchronization therapy (CRT).
Methods: In patients (pts) undergoing CRT device implantation, a detailed venogram was obtained, and the CS-SB of first, second, third, and fourth choices for CS-lead implantation was defined. Study endpoints included successful LV lead implantation in the first choice CS-SB, number of CS-SB potentially available, implantation success in selected CS-SB, procedural variables, and 6-month response to CRT.
Results: CRT defibrillator implantation was attempted in 77 pts. Only 1 suitable CS-SB was present in 3 (4%), 2 in 20 (26%), 3 in 36 (47%), and 4 CS-SB in 18 patients (23%). The LV lead was implanted in the first choice CS-SB in 71% of patients, in the second choice in 16%, in the third choice in 3%. In 4 patients (5%) no LV lead could be implanted. Implant success was similar for different CS-SB regions (P = ns). Successful LV lead implantation in the CS-SB of first choice was associated with median fluoroscopy and procedure times of 20 +/- 13 and 143 +/- 41 minutes. Corresponding times for the CS-SB of >or= second choice were 38 +/- 21 (P = 0.002) and 179 +/- 47 minutes (P = 0.002). Response rate at 6 months was 64% for patients with LV leads in the first target CS-SB.
Conclusions: In 70% of patients undergoing CRT device implantation, at least three suitable CS-SBs are available. Implant success in the CS-SB of first choice is 71% without significant differences for any particular CS-SB region.